Dataset Information

Dental Care for Asylum-Seekers in Germany: A Retrospective Hospital-Based Study.

ABSTRACT: Background: The growing immigration to Germany led to more patients whose medical needs are divergent from those of the domestic population. In the field of dental health care there is a debate about how well the German health system is able to meet the resulting challenges. Data on asylum-seekers' dental health is scarce. This work is intended to reduce this data gap. Methods: We conducted this retrospective observational study in Halle (Saale), Germany. We included all persons who were registered with the social welfare office (SWO) in 2015 and received dental treatments. From the medical records, we derived information such as complaints, diagnoses, and treatments. Results: Out of 4107 asylum-seekers, the SWO received a bill for 568 people. On average, there were 1.44 treatment cases (95%-CI: 1.34-1.55) and 2.53 contacts with the dentist per patient (95%-CI: 2.33-2.74). Among those, the majority went to the dentist because of localized (43.2%, 95%-CI: 38.7-47.7) and non-localized pain (32.0%, 95%-CI: 27.8-36.2). The most widespread diagnosis was caries (n = 469, 98.7%, 95%-CI: 97.7-99.7). Conclusion: The utilization of dental care is lower among asylum-seekers than among regularly insured patients. We assume that the low prevalence rates in our data indicate existing access barriers to the German health care system.

SUBMITTER: Freiberg A

PROVIDER: S-EPMC7215588 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Dental Care for Asylum-Seekers in Germany: A Retrospective Hospital-Based Study.

Freiberg Anna A Wienke Andreas A Bauer Lena L Niedermaier Andreas A Führer Amand A

International journal of environmental research and public health 20200413 8

<i>Background:</i> The growing immigration to Germany led to more patients whose medical needs are divergent from those of the domestic population. In the field of dental health care there is a debate about how well the German health system is able to meet the resulting challenges. Data on asylum-seekers' dental health is scarce. This work is intended to reduce this data gap. <i>Methods:</i> We conducted this retrospective observational study in Halle (Saale), Germany. We included all persons wh ...[more]

PMID: 32295091

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Project description:BackgroundHealth monitoring in Germany falls short on generating timely, reliable and representative data among migrants, especially transient and marginalized groups such as asylum seekers and refugees (ASR). We aim to advance current health monitoring approaches and obtain reliable estimates on health status and access to essential healthcare services among ASR in Germany's third largest federal state, Baden-Württemberg.MethodsWe conducted a state-wide, cross-sectional, population-based health monitoring survey in nine languages among ASR and their children in collective accommodation centres in 44 districts. Questionnaire items capturing health status, access to care, and sociodemographic variables were taken from established surveys and translated using a team approach. Random sampling on the level of 1938 accommodation centres with 70,634 ASR was employed to draw a balanced sample of 65 centres with a net sample of 1% of the state's ASR population. Multilingual field teams recruited eligible participants using a "door-to-door" approach. Parents completed an additional questionnaire on behalf of their children.ResultsThe final sample comprised 58 centres with 1843 ASR. Of the total sample expected eligible (N?=?987), 41.7% (n?=?412) participated in the survey. Overall, 157 households had children and received a children's questionnaire; 61% (n = 95) of these were returned. Age, sex, and nationality of the included sample were comparable to the total population of asylum applicants in Germany. Adults reported longstanding limitations (16%), bad/very bad general health (19%), pain (25%), chronic illness (40%), depression (46%), and anxiety (45%). 52% utilised primary and 37% specialist care services in the previous 12 months, while reporting unmet needs for primary (31%) and specialist care (32%). Younger and male participants had above-average health status and below-average utilisation compared to older and female ASR.ConclusionsOur health monitoring survey yielded reliable estimates on health status and health care access among ASR, revealing relevant morbidities and patterns of care. Applying rigorous epidemiological methods in linguistically diverse, transient and marginalized populations is challenging, but feasible. Integration of this approach into state- and nation-wide health monitoring strategies is needed in order to sustain this approach as a health planning tool.

Project description:BACKGROUND:Asylum seekers are a vulnerable group with special needs in health care due to their migration history and pre-, peri- and postmigratory social determinants of health. However, in Germany access to health care is restricted for asylum seekers by law and administrative regulations. METHODS:Using claims data generated in the billing process of health care services provided to asylum seekers, we explore their utilization of health care services in the outpatient sector. We describe the utilization of outpatient specialties, prevalences of diagnoses, prescribed drugs and other health care services, as well as total costs of health care provision. RESULTS:The estimated prevalence for visiting an ambulatory physician at least once per year was 67.5% [95%-Confidence-Interval (CI): 65.1-69.9%], with a notably higher prevalence for women than men. The diagnoses with the highest one-year prevalence were "Acute upper respiratory infections" (16.1% [14.5-18.0%]), "Abdominal and pelvic pain" (15.6% [13.9-17.4%]) and "Dorsalgia" (13.8% [12.2-15.5%]). A total of 21% of all prescriptions were for common pain killers. Women received more diagnoses across most diagnosis groups and prescribed drugs from all types than men. Less than half (45.3%) of all health care costs were generated in the outpatient sector. CONCLUSION:The analysis of claims data held in a municipal social services office is a novel approach to gain better insight into asylum seekers' utilization of health services on an individual level. Compared to regularly insured patients, four characteristics in health care utilization by asylum seekers were identified: low utilization of ambulatory physicians; a gender gap in almost all services, with higher utilization by women; frequent prescription of pain killers; and a low proportion of overall health care costs generated in the outpatient sector. Further research is needed to describe structural and individual factors producing these anomalies.

Project description:Access to health care for asylum-seekers and refugees (AS&R) in Germany is initially restricted before regular access is granted, allegedly leading to delayed care and increasing costs of care. We analyse the effects of (a) restricted access; and (b) two major policy reforms (1997, 2007) on incident health expenditures for AS&R in 1994-2013.We used annual, nation-wide, aggregate data of the German Federal Statistics Office (1994-2013) to compare incident health expenditures among AS&R with restricted access (exposed) to AS&R with regular access (unexposed). We calculated incidence rate differences (?IRt) and rate ratios (IRRt), as well as attributable fractions among the exposed (AFe) and the total population (AFp). The effects of between-group differences in need, and of policy reforms, on differences in per capita expenditures were assessed in (segmented) linear regression models. The exposed and unexposed groups comprised 4.16 and 1.53 million person-years. Per capita expenditures (1994-2013) were higher in the group with restricted access in absolute (?IRt = 375.80 Euros [375.77; 375.89]) and relative terms (IRR = 1.39). The AFe was 28.07% and the AFp 22.21%. Between-group differences in mean age and in the type of accommodation were the main independent predictors of between-group expenditure differences. Need variables explained 50-75% of the variation in between-group differences over time. The 1997 policy reform significantly increased ?IRt adjusted for secular trends and between-group differences in age (by 600.0 Euros [212.6; 986.2]) and sex (by 867.0 Euros [390.9; 1342.5]). The 2007 policy reform had no such effect.The cost of excluding AS&R from health care appears ultimately higher than granting regular access to care. Excess expenditures attributable to the restriction were substantial and could not be completely explained by differences in need. An evidence-informed discourse on access to health care for AS&R in Germany is needed; it urgently requires high-quality, individual-level data.

Dataset Information

Dental Care for Asylum-Seekers in Germany: A Retrospective Hospital-Based Study.

Publications

Dental Care for Asylum-Seekers in Germany: A Retrospective Hospital-Based Study.

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